RELEASE OF LIABILITY AND ASSUMPTION OF RISK:
EACH ATTTENDEE MUST INDIVIDUALLY SIGN THIS FORM.
I (we) am aware that during the 2010 IPS Biennial Tour and its excursions in which I am participating under the arrangements of the International Palm Society and/or the New York Botanical Gardens and/or Turismo TOP and/or Vipitour Tourismo and their agents or associates, certain risks and dangers may occur, including but not limited to, the hazards of traveling in mountainous or jungle or river areas, accident or illness in remote places without medical facilities, the forces of nature and travel by air, boat, automobile, or other conveyance. In consideration of, and as part payment for, the right to participate in such trips or other activities, services and food arranged for me by the IPS and all persons connected thereof, I have and do hereby assume all of the above risks and will hold them harmless from any and all liability, actions, causes of action, debts, claims, demands of every kind and nature whatsoever which I now have or which may arise of or in connection with my trip or participation in any other activities arranged for me by the entities named above. The terms hereof shall serve as a release and assumption of risk for my heirs, executors, and administrators and for all members of my family including any minors accompanying me. I have read and agree to the above conditions and release of liability and assumption of risk.
I understand that information packets will be forwarded to attendees after February 15, 2010.
I further understand that it is my responsibility to obtain any required Brazilian Visas, as well as my own health and accident or other insurance needed for these events.
ALL Biennial Participants must sign below. IF NOT, PLEASE DO SO BEFORE SUBMITTING.]
SIGNATURE(S):_______________________ _/_____________________ _ DATE _______________
SIGNATURE(S):_______________________ _/_____________________ _ DATE _______________
MAIL OR FAX THIS COMPLETED FORM WITH PAYMENT (IF NOT ALREADY SUBMITTED) TO:
Jim Cain
12418 Stafford Springs Drive
Houston, TX 77077-3910 USA
E-mail: Jim.Cain@Cain-Barnes.com
Tel: +1 (832) 215-5551
Fax: +1 (281) 556-1084
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